Rheumatologist Shortage Growing, New Models Needed

Bridget M. Kuehn

February 05, 2018

The shortage of full-time rheumatologists is expected to grow to more than 4133 by 2030, as the aging population grows and more rheumatologists adopt part-time schedules, according to new projections.

The shortage is expected to be particularly acute in already-underserved areas. Reducing the effect of the projected shortage will require new models of care and training, according to a pair of articles published online February 5 in Arthritis Care & Research and Arthritis & Rheumatology, which detail the projected shortage. Recommendations for closing the gap include training more rheumatologists; efforts to recruit rheumatologists to underserved areas; more rheumatology training for nurse practitioners, physician assistants, and other clinicians; and increased use of telemedicine.

"Based on our projected rheumatology workforce shortages, innovative strategies will be needed to address access to patient care, as it will not be possible to solve the supply-demand gap by training more rheumatologists alone," Seetha Monrad, MD, senior author of the article published in Arthritis Care & Research projecting the shortage and associate professor of rheumatology at the University of Michigan in Ann Arbor, said in a news release.

A previous assessment of the rheumatology workforce in 2005 projected a shortage of about 2576 rheumatologists by 2025. That projection led the American College of Rheumatology to increase the number of rheumatology fellowships from 396 to 470 by 2015. The organization also boosted recruitment of nurse practitioners and physician assistants to the field.

The new projections account for factors affecting the overall supply of rheumatologists and the demand for care, as well as changes in physician work hours. Dr Monrad and colleagues found that more than half of rheumatologists plan to retire in the next 10 to 15 years, and 80% of those retiring physicians anticipate cutting their patient load by a quarter in their final years of practice. The growing ranks of women in the field will also have an effect, as female rheumatologists work on average 7 fewer hours per week and see 30% fewer patients than their male counterparts.

In addition, millennial rheumatologists who place high priority on work–life balance will account for 44% of the workforce by 2030. This cohort also sees fewer patients than previous generations, according to the authors.

Currently underserved areas are likely to feel the brunt of the shortage. As of 2015, rheumatologists were already concentrated in urban areas of the Northeast, Mid-Atlantic, and Great Lakes regions; regions such as the Northwest and Southwest have far fewer rheumatologists.

Meeting the growing demand will require finding creative ways to extend the rheumatology workforce. For example, Dr Monrad and colleagues write that reducing the burden of regulatory and insurance requirements may help free up some clinician time.

New nonfederal funding sources for rheumatology fellowships might also help, noted Marcy Bolster, MD, lead author of the article published in Arthritis & Rheumatology and director of the Rheumatology Fellowship Training Program at Massachusetts General Hospital in Boston. In addition, efforts to increase access to care in underserved areas through telemedicine or incentives for clinicians to practice in those areas are needed, said Daniel Battafarano, DO, a coauthor of both articles and a rheumatologist at the San Antonio Military Medical Center in Texas, said in the news release.

In an accompanying editorial published in Arthritis & Rheumatology, William F. Harvey, MD, an assistant professor of rheumatology at Tufts University School of Medicine in Boston, and colleagues emphasize the importance of rheumatology mentoring in medical training programs to attract and retain the next generation of physicians to rheumatology.

"We need our women and men to support all students, trainees and faculty, but especially women and underrepresented minorities at each stage of their career so that they see our specialty as their natural home within medicine," Dr Harvey and colleagues write.

The authors have disclosed no relevant financial relationships.

Arthritis Care Res. Published online February 5, 2018. Abstract

Arthritis Rheumatol. Published online February 5, 2018. Article abstract, Editorial extract

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